Written by Rebecca Budde, SIU School of Medicine

Americans do a good job taking in about 1½ teaspoons of salt daily with most of the sodium hidden in common processed foods and restaurant meals.  This amount of salt is about 1/3 more than is recommended for good health and enough to increase the risk of high blood pressure, stroke and other health problems. The American Heart Association recommends a daily limit of no more than 1500 milligrams sodium daily – that’s about the amount in 2/3 of a teaspoon of salt.

Salt is composed of 40% sodium and 60% chloride, but it’s the sodium part that is a problem.  Sodium is found not only in processed and restaurant foods, but in many condiments (for example, catsup), seasonings, poultry, cheese, breads and meats.

Gayle Jennings, a registered dietitian and Certified Diabetes Educator with SIU Family and Community Medicine suggests these simple ways to cut out the extra salt:

• Buy fresh or frozen foods more often than canned.  For instance, ½ cup canned green peas has approximately 215mg of sodium, while ½ cup frozen peas have less than 60mg of sodium.
• Cook food from scratch rather than eating prepared foods. Fast foods, frozen dinners and canned foods are higher in sodium.
• Use spices, herbs and sodium-free seasonings in place of salt. Check with your physician before using salt substitute.  While sea salt has boomed in popularity, it isn’t any less salty.  Just like table salt, sea salt typically contains 40% sodium.
• Drain and rinse canned vegetables, beans, meats and fish with water to remove about 40% of the sodium.
• Always read the Nutrition Facts label to compare foods.  Choose foods with the lowest Percent Daily Value (%DV) for sodium.  A %DV of 5% or less is low in sodium; a %DV with 20% or more is high in sodium.

The Food and Drug Administration (FDA) has been pushing for the food industry to lower sodium in their food products, but having a lot of resistance. According to Jennings, “The strongest voice is from the consumer; look for lower sodium options and purchase them. That is what drives food manufactures to change.”

Copyright ©, SIU School of Medicine, Springfield, Illinois

Written by Rebecca Budde, SIU School of Medicine
Do you find yourself talking with your doctor’s nurse or physician assistant more often than you used to? Does it sometimes take longer than you wish to schedule an appointment with your doctor? Do you ever feel like you need more time at your appointment?
The disproportionate number of Americans needing health care and the amount of providers who can meet their needs continues to be an issue for the country.
The reasons:

1. an increase in the aging population
2. an increase in chronic conditions
3. the Affordable Care Act giving medical coverage to more people

So what’s going on in the medical world to help this problem?
Increasing the number of health care providers such as physician assistants (PA) and nurse practitioners (NP) could alleviate the physician shortage, according to the U.S. Department of Health and Human Services. Planning for the future has caused health education programs, including SIU School of Medicine, to think differently about how to train health care providers.
SIU School of Medicine’s rigorous Physician Assistant program in Carbondale runs consecutively for 26 months. (Read more about the program here.) Students learn from traditional studies as well as labs, lectures and hands-on clinical experience.
What does the future hold for these careers?
The U.S. Bureau of Labor Statistics predicts a 38.4% increase in the employment of physician assistants from 2012-22, a much faster growth than other occupations. This need for providers combined with competitive salaries and flexible work hours makes physician assistants #1 on a list of the best jobs in America for 2015, according to U.S. News & World Report.
But what’s in it for the patient?
Some patients specifically ask for the PA or NP because they may have more time to spend listening to them or the patient may just have a better rapport with that person. Becky Hanna, a physician assistant for SIU Family and Community Medicine, says physician assistants can help with patients who have tight schedules or lack transportation and can only come to appointments on certain days when the doctor isn’t in clinic. (Read more about SIU’s PAs here.)
Physician assistants and advanced practice nurses are essential in the health care model: They can contract with insurance companies, Medicare and Medicaid; order labs and tests; diagnose and even prescribe medication. The future of the health care system is dependent upon the growth of these providers working together with physicians.
Copyright © SIU School of Medicine, Springfield, Illinoi

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Written by Rebecca Budde, SIU School of Medicine
The Zika virus has made headlines as infested mosquitos caused alarm for travelers and citizens in areas such as Mexico, Central and South America, the Caribbean and Pacific Islands. Recent reports say that Illinoisans should also take precautions as the pesky, infected skeeters have found their way further north.
Dr. Janak Koirala, an infectious disease doctor at SIU School of Medicine, cautions that the ZIka virus is a nationally notifiable condition.

Who’s at risk?
Women who are pregnant or plan to become pregnant are at an especially greater risk, warns the CDC. Pregnant women who have been infected with the virus may experience poor pregnancy outcomes, including microcephaly, a birth defect in which the baby’s head is smaller than expected when compared to babies of similar age and gender. Babies with microcephaly often have smaller brains that might not have developed properly, which could lead to future health problems.

What are the symptoms?
“Only about 20% of people who are infected with the Zika virus will show symptoms,” Dr. Koirala explains. If symptoms do occur, they may take a few days to a week to be noticed, and they usually last for a couple days to a week. Some people may experience fever, rash, red eyes and joint and muscle pain, or a headache.

“Patients who develop symptoms should be sure to get plenty of rest, drink fluids to prevent dehydration and take acetaminophen for fever or pain,” Dr. Koirala says. He cautions patients to avoid NSAIDS, such as aspirin and ibuprofen, until a doctor makes a diagnosis.

How can I prevent Zika Infection?
Dr. Koirala recommends avoiding travel to Zika-outbreak areas and seeing a health care provider before and after travel. He gives these tips to reduce mosquito exposure:

1. Use air conditioning or window/door screens, bed-nets
2. Use mosquito repellents (e.g. DEET >30%) on exposed skin
3. Wear long-sleeved shirts and long pants
4. Spray and wear permethrin-treated clothing
5. Empty standing water from outdoor containers

Because Zika can also be sexually transmitted, when a man returns after traveling to a Zika virus affected area, the CDC further recommends the following:

1. If the female partner is pregnant, abstain or use condoms throughout pregnancy
2. If man is symptomatic and female partner is not pregnant, abstain or use condoms for 6 months
3. If man is asymptomatic and female partner is not pregnant, abstain or use condoms for 8 weeks

For more information and updates on the Zika virus, visit the CDC webpage at www.cdc.gov/zika/index.html.
Copyright © SIU School of Medicine, Springfield, Illinois

Written by John M. Flack, MD, MPH, hypertension specialist at SIU School of Medicine

Hypertension, or high blood pressure, is very common: it affects nearly 80 million adults in the United States. Hypertension has been labeled the “silent killer” due to the absence of symptoms linked to this life-shortening condition. However, this label is unfortunate because many, though not all, individuals with hypertension have symptoms linked to their elevated blood pressure, including fatigue, headaches and chest pain.

What is hypertension?

Hypertension is the result of elevated pressure inside the arterial blood vessels. We estimate how high the pressure is inside the blood vessels by inflating a blood pressure cuff over the brachial artery in the arm and listening with a stethoscope.

Why is it important to know if I have high blood pressure?

Many adult Americans have high blood pressure, which contributes to a shorter than normal life-span, heart failure, heart attacks, stroke, kidney failure, peripheral vascular disease and dementia. In men, elevations in blood pressure can increase the chance of having erectile dysfunction. The risk of these problems relates both to how high the blood pressure is, particularly the systolic blood pressure (top number), and how long the blood pressure has been elevated. In persons with diabetes, hypertension is the major cause of bleeding in the eyes.

How do I know if I have hypertension?

A doctor or nurse can measure your blood pressure with a cuff and listening device, such as a stethoscope. Blood pressure is considered to be elevated when the systolic blood pressure (top number) exceeds 120 mm Hg and/or the diastolic blood pressure (bottom number) exceeds 80 mm Hg. Check out this blog to learn what the numbers mean. Patients with hypertension may have one or more symptoms – headache, sleep disturbance, weakness, fatigue, poor exercise tolerance, nervousness or chest pain. However, these symptoms are not specific enough to diagnose hypertension. These symptoms typically improve when the blood pressure level is lowered.

Who is at risk for hypertension?

Hypertension is an age-related condition. However, given the high levels of obesity and lack of physical activity in children and adolescents, hypertension is increasing in younger people. Hypertension is not inevitable with advancing age. Diet, exercise and weight affect our chances of developing hypertension.

Major dietary influences include the amount of sodium (salt) in our diets; the higher one’s salt intake, the greater the risk for hypertension. About 70% of the salt in our diets comes from the processed foods we eat. Potassium intake from fruits and leafy, green vegetables protects against developing high blood pressure. Too much alcohol intake (more than two drinks per day in men and one drink per day in women) will raise blood pressure. Recent studies have suggested that the risk of hypertension increases in persons with vitamin D deficiency. African Americans tend to develop more severe hypertension at earlier ages than whites.

How do I treat my hypertension?

The same things that prevent the development of hypertension – weight loss, a low sodium diet, exercise and avoiding excess alcohol – will also lower your blood pressure. However, in many patients, this will not be enough to keep the blood pressure below 140/90 mm Hg and medication may be necessary. Most patients will ultimately need more than one drug to keep the blood pressure controlled, but blood pressure medications do not “cure” hypertension.

When might I need to see a hypertension specialist?

• If your blood pressure is difficulty to control despite medication
• If you are experiencing significant side effects from your blood pressure medications
• If your doctor thinks you might have a secondary cause for your hypertension, such as a problem in your adrenal gland
• If your doctor thinks you might need specialized testing, such as 24-hour ambulatory blood pressure monitoring.

If you or a loved one is struggling to control high blood pressure, make an appointment with Dr. Flack or another specialist at SIU HealthCare’s new hypertension clinic by calling 217-545-8000. Appointments are available on Wednesdays and Thursdays.

Dr. Flack, MD, MPH, FAHA, FASH, FACP, is a professor of medicine and chair of the Department of Internal Medicine at SIU School of Medicine.

Written by Lauren Murphy, SIU School of Medicine

While you scour the woods for morel mushrooms and other springtime delicacies, you could be the target of another creature’s appetite.

The American dog tick, or hard tick, is the most common type of tick in Central Illinois. A bite from this little arachnid (that’s right, ticks fall into the same category as spiders!) can lead to Rocky Mountain spotted fever, tularemia and possibly ehrlichiosis in humans.

Many ticks, including the American dog tick as well as the deer tick which causes Lyme disease, are most active April through June. “When it comes to tickborne diseases, we are very fortunate to be living in the era of awareness,” says Dr. Vidhya Prakash, an infectious diseases specialist at SIU School of Medicine. “While almost all of these infections are treatable with appropriate therapy, prevention is key to combatting disease.”

As you head outdoors this spring, SIU physicians recommend taking these preventative measures:

• Avoid wooded or brushy areas
• Walk in the center of trails
• Use insect repellent containing 20-30% DEET on exposed skin and clothing
• Apply products that contain permethrin to clothing. The CDC recommends treating all clothing and gear, including boots, pants, socks and tents, with products containing 0.5% permethrin. One treatment will continue to protect even after several washings.

While taking these precautions is a good start, experts also recommend doing a thorough check after coming indoors.

• Scrub up in the shower or bathtub, preferably within two hours of being outside
• Perform a full-body tick check using a handheld or full length mirror. Parents should also check their children, especially in their hair, under the arms, in and around the ears, inside the belly button, behind the knees, between the legs and around the waist.
• Check out your gear and pets. While you may not find any ticks during your full-body check, the little pests could hitch a ride on your gear or canine companion and attach to you later.
• Throw your clothes in the dryer on high heat for an hour to kill remaining ticks

What should you do if you find a tick on your clothes, or worse, on your skin?

• You can remove ticks found crawling on your clothes with tape. Just make a ring of tape around your hand (sticky side out, attach the ends) and the critters will stick to the tape. You can then fold over the tape and place it in the trash.
• Remove any tick found on your body ASAP!
  • Grasp the tick firmly with tweezers and pull it (gently, but firmly) straight out.
  • If you don’t have tweezers, use a piece of tissue. Never use your bare hands since the secretions from the tick can cause disease.
  • Dispose of the tick by flushing it down the toilet. You can also stick it to tape and throw the tape away in the garbage.
  • Wash your hands and the bite site with soap and water.
  • Call your physician if you experience any rash or unexplained fever.

Source: http://www.idph.state.il.us/envhealth/pccommonticks.htm

Copyright © SIU School of Medicine, Springfield, Illinois

Written by Rebecca Budde, SIU School of Medicine
The sun is shining, and after a long, cold Illinois winter, it sure feels good. But we know over exposure to the sun is not good for us. According to the CDC, skin cancer is the most common form of cancer in the United States. SIU dermatologist Dr. Stephen Stone encourages people to do self-examinations for changes in their skin and have skin screenings to detect skin cancer in its early stages. See the infographic on the right to help you with self-examinations. If in doubt, always seek the advice of your physician.
The best advice to avoid skin cancer:  limit exposure to the sun, especially during the peak hours of 10 am- 4 pm. Wear a sunscreen of SPF 30 or higher and be sure to cover the often forgotten lips and ears. Hats help protect the scalp, and sunglasses keep sensitive eyes from damaging exposure.
Copyright ©, SIU School of Medicine, Springfield, IL 

Written by Steve Sandstrom, SIU School of Medicine
Within today’s global health care environment, medical advances occur with reassuring regularity.  Research is the main driver behind this progress. Men and women in research laboratories conduct studies to understand the nuances of diseases, and when a discovery occurs, a new treatment can be developed to improve outcomes. Health care providers then have more options to offer their patients.
At the end of April, a two-day symposium at the School of Medicine showcased the research being done by SIU students and physicians in training. Participants included medical students, graduate students, resident physicians and fellows. The young scientists are working within four departments: Biochemistry & Molecular Biology; Physiology; Pharmacology; and Medical Microbiology, Immunology & Cell Biology.
A committee of SIU School of Medicine faculty members judged 25 presentations and research posters. The award-winning presentations included:
THYROID CANCER.  A study led by Dr. Alexandria McDow examined data from nearly 120,000 patients with thyroid cancer. She measured health risk and outcomes by regions. Finding: Patients in urban areas are at higher risk for the disease but have a better survival rate than patients within rural areas.  
REDUCING STROKE RISK.  Second-year medical student Michael Romanelli compared surgeries performed in Springfield against a database of more than 1.5 million patients who underwent a carotid endarterectomy (CEA), a common surgical procedure to reduce stroke risk due to a narrowing in the carotid arteries. The procedure removes material on the inside of the artery. Finding: Patients who were given statins (blood thinners) had shorter hospital stays, fewer complications and lower costs both locally and nationally.
MUSCLE DEVELOPMENT.  Carbondale-based grad student Jessica Whitaker found a way to use light to regulate muscle activity in baby chick embryos. Chicken embryos provide a model for studying similar embryonic behavior in humans. Finding: Whitaker’s procedure will allow for more refined studies of the roles of muscle activity in neuromuscular development; for example, how it travels along the spine’s circuitry.
EMPHYSEMA.  Post-doctorate fellow Nisha Rizvi, PhD, assessed the clinical outcomes and quality of life of emphysema patients after they had lung volume reduction surgery. SIU is one of only a five institutions in the country that offers this surgery. It was developed by Dr. Stephen Hazelrigg, director of cardiothoracic surgery at SIU School of Medicine. Finding: Despite improvements in standards of health, comfort and happiness expressed by patients one year after surgery, clinical tests should still be performed.

With every successful research study completed, scientifically tested facts emerge. Other labs can then replicate and build upon them. Through this gradual but crucial process, we reach a better understanding of the human condition, and medical care advances.
Copyright © SIU School of Medicine, Springfield, Illinois

Written by Lauren Murphy, SIU School of Medicine

Lisa Jones sits in the exam room clutching an oversized sweatshirt at her waist. Her tiny frame is swallowed by a baggy, brown T-shirt and shapeless, gray sweatpants. Her forearm is wrapped in a white bandage. She drops her head, letting her tangled blonde hair fall over her tear-stained face. Her blue-collar husband, who looks as sad as he is frustrated, sits down next to her.

“You’ve got to tell her,” he pleads with his wife. “She can’t help you if you don’t talk to her.”

The young doctor reaches from her stool and gently touches Lisa’s knee. “I’m so sorry you’re feeling this way,” she says. “Can you tell me, are you on any types of medications?”

“That’s the other thing,” her husband interjects. “She quit taking her meds.” Lisa mumbles that the antidepressant wasn’t working. “What’s the point?” she asks. “There’s no reason for me to be here anymore.”

A knock at the door signals the end of the appointment. Just as the doctor steps out of the room, the actor playing Lisa whips her head up, throws back her hair to reveal a grin and begins to sing, ”Grey skies are gonna clear up!” “That was so draining!” she confesses.

Cindy Heady is one of more than 150 standardized patients (SPs) at SIU School of Medicine. The “doctor” is played by first- through fourth-year medical students who must pass 14 clinical practice exams in their senior year of training. Since 1981, the School of Medicine has used actors to facilitate medical training and improve students’ bedside skills.

In April, the School hosted its 30^th workshop on training and using standardized patients. Attracting participants from around the world, the five-day workshop not only teaches guests from other medical schools, but also police officers, nurses, social workers, athletic trainers and veterinary school instructors.

“Our workshop teaches participants how to use standardized patients to teach and evaluate the clinical performance, communication and interaction skills of medical students and others who work in the health care field,” explains Mary Aiello, director of the Professional Development Lab at SIU. “By the time our students graduate, they will have seen more than 50 SPs.”

To read more about how SIU uses standardized patients to train medical students, visit www.siumed.edu/oec/standardizedpatients/.